NEED FOR STUDY - Rajiv Gandhi University of Health...
Transcript of NEED FOR STUDY - Rajiv Gandhi University of Health...
6.0 BRIEF RESUME OF THE INTENDED WORK.
“The 1st Hour save 1 Million Babies”
6.1 INTRODUCTION
Children are our future and our most precious resources .After birth the health
of the baby depends on the nurturing practices adopted by the families.9 The basic food
for infant feeding is milk .Breastfeeding is the most natural method .Breast milk is the
natural food for babies. It provides all the energy and nutrients that needs for the first
months of life, and it continuous to provide up to half or more of a child‘s needs during
the 2half of the first year.2
W H O [1991] defines Breastfeeding as the child has received breast milk
[direct from the breast or expressed].4 Breastfeeding should be initiated within the first
half an hour after birth. The first milk is the most suitable food for the newborn. It is thick
and yellow colored the SHAASTRAS call it PEEYUSHA AND WESTERN SCIENCE
uses the word Colostrum.9 Breast milk always fresh, pure, readymade, requiring no
preparations. It is also at the right temperature, uncontaminated and aseptic.13
Breast milk promotes sensory and development, immunological and psychological
development. Protects the infant against infectious diseases such as diarrhea, lower
respiratory tract infections, otitimedia, bacteriemia, bacterial meningitis, botulism,
urinary tract infections and necrotizing enterocolitis, chronic diseases childhood leukemia
among neonates.2 According to WHO\UNICEF document at least 1 million deaths per
year from diarrhea; infections are absolutely preventable through breast feeding. The
incidence of respiratory and intestinal infections in breast fed infants is far less than that
of reported in bottle fed babies and breast fed babies have seven times less chance of an
allergy.
Respiratory infections ---5%[in breast fed] ,28%[in bottle fed].
Gastrointestinal infections---6%[ in breast fed],37%[ in bottle fed].13
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Exclusive breast feeding means giving only breast milk. This means no water,
liquids, teas, herbal preparations, or foods through the first six months of life.
International guide lines recommended exclusive breast feeding for the first six months
based on scientific evidence of the benefits for infant survival, growth and cognitive
development and helped to reduce mortality and morbidity rate of neonates’ world wide.
The WHO/UNICEF jointly developed the Global Strategy for infant and young children
feeding which has adopted on 18 may 2002 by the World Health Assembly and endorsed
by UNICEF Executive Board in September 2002.. This strategy aims to set in motion
national actions to improve infant and young child feeding practices world wide, having
their impact on child health, development and survival. August 1 through 7is World
Breast Feeding Week and the Governor has proclaimed August as Breast Feeding
Awareness Month.(WHO / UNICEF)
Number of studies mentioned health benefits of breast fed mothers also .It is
documented that breast feeding increases level of oxytocin, resulting in less post partum
bleeding and more rapid uterine involution and lactating mother have an easier return to
pre pregnant weight, delayed resumption of ovulation with increased child spacing,
improved bone remineralalization and post partum with reduction in hip circumference It
reduces risks of breast cancer of. Pre menopausal endometrial cancer and ovarian cancer.4
As reported there are many barriers which interfere with the success of breast
feeding .Some of these barriers are poor knowledge among health, problems of mothers,
Medical surgical problems of the neonates, in appropriate hospital practices such as
separation of mother and infant soon after birth, delay in getting the infant soon after
birth, anxiety of the mother also has direct effect on lactation.5
6.2 NEED FOR STUDY
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Exclusive Breast Feeding means giving only breast milk .This means no water, liquids,
teas, herbal preparations, or foods through the first six months of life. Human milk is
decidedly superior to other, milks13 and is universally acknowledge as the best and
complete food for infants including sick and preterm as it full fill their specific nutritional
needs. The protective benefits of breast milk for neonates and mothers are well
documented in studies conducted in both developed and developing countries among
various socio economic strata of the society. Breast milk has the best potential help the
babies grow well in later stages of child hood.5
Initiation of breast feeding with in the first half an hour of birth is the first and
most vital step towards reducing infant and under five mortality, by reducing the over
whelming high neonatal mortality rate .save one million babies –beginning with one
action, one hour support and one message. This single intervention can save more than
2.5 lakhs babies in India that is equivalent to 22% of deaths among newborns. In a world
where more than 10 million children die before their fifth birthday due to preventable
causes, malnutrition alone kills more than half of these children. Improving breast
feeding practices saves lives, especially in poor communities.
In the year 2005, a review by Cochrane Collaboration on breast feeding interventions
concluded that malnutrition has been responsible ,directly or in directly, for 60% of the
10.9 million deaths annually among children under five well over two thirds of these
deaths ,which are often associated with in appropriate feeding practices occur during the
first year.
A UNICEF 2007 report states that India has close to 25 million children born every
year .Out of these 1.9 million are under five children, who die in a year. Among the
deceased children, 1.4 million children die just with in 1 year and roughly. One million
children dying with malnutrition and other preventable diseases caused mainly due to
poor care and inappropriate infant feeding practices, delaying and restricting breast feeds
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and giving other products before six months are still common practices which increases
the risk of infection, allergy, long term diseases and death.
Only 23.4% newborns across the country begin breast feeding with in an hour of
birth. This rate has to be improved up to 90% or more in order to achieve Millennium
Development Goals and to fight against the malnutrition and child deaths in India. Early
initiation if breast feeding practice provides quality health care for children and reduces
their specific health problems. Maximum number of child deaths occurs within first
month and first year of life and it is the most crucial period for the children. It can be
safeguard by initiating proper infant feeding practices along with adequate sequence.
WHO also recommends for optimal infant feeding practices to fight Malnutrition and
promote child survival.7 The number of studies has shown protective effect of human
milk feed against sudden infant death syndrome, insulin dependent diabetes mellitus
crohn’s disease, ulcerative colitis, lymphoma, allergic and other chronic digestive
diseases.
But some of the factors affecting the success of breast feeding which are
- Mothers of newly born children don’t know how to feed, what to feed, and end up
adopting harmful practices.
-Lack of knowledge among mothers.
-Medical surgical problems of neonates.
-Inappropriate hospital practices such as separation of mother and infant
soon after birth bonding and suckling reflexes are strong.
-Delay in getting the infant to the breast.
-Increased level of anxiety of the mother.
-Provision of formula feed.
-Following rigid feeding schedule based on clock rather than on neonate’s demand.
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-More over the cultural influence an inadequate or lack of health care support makes it
worse.4
This is supported by a study conducted by Mrs. .V .Selvanayaki,[2003] did study
conducted on knowledge, attitude, practices of breast feeding among employed mother
with below six months of age child.. This study reveled that majority [45%] of the
mothers had average knowledge and 67% had positive attitude towards breast feeding but
practices was partially adoptive for 52% and completely adoptive for 43% of
mothers .However majority of them were not practing exclusive breast feeding.
Recommendation of the study was they need to be educated on exclusive breast feeding
on joy by using self instructional module or structured teaching programme.11
Hence the researcher felt need to be conducted study on knowledge practices of
exclusive breast feeding with a view to develop an information guide sheet.
6.3 REVIEW OF LITERATURE.
Review of literature for the study has been under the following
Field E, Siziva S, Kanakasa C, Moland KM, TylleskarT [2008] conducted a
qualitative approach on assessment of potentials and barriers in the promotion of
exclusive breast feeding in Mazabuka, 130 km south of Lusaka in Zambia among
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Mothers, fathers, health staff, grand mothers, traditional birth attendants in urban and
rural areas. the study reveled that exclusive breast feeding was to be universal, the use of
pre-lacteal feeds appeared to be low, colostrums was rarely discarded, and attitudes to
and knowledge about exclusive breast feeding were good .The barriers reveled were the
perception of insufficient milk, the fear of dying or becoming too sick to be able to breast
feed, convection, the perception of bad milk, lack of knowledge on the subject.
Conclusions of the study were that exclusive breast feeding is beneficial for child health
had reached the health workers and was taught to mothers.1
Suneth B Agammpodi, Thiilini C Agampodi, [2007] conducted cross sectional study
was in the Medical Officer of Health area, Beruwala ,Sri Lanka among 219 mothers
with aged 4to 12 months .The study reveled that the rates of exclusive breast feeding at
4and 6 months were 61.6% [135/219] and 15.5%[24/155] respectively .At the time of the
study,62%[135/2219]of infants were receiving feeds via a bottle and 23%[51/219] were
receiving infant formula. The study concluded that breast feeding and exclusive breast
feeding up to the 4 month is very high in the Medical Officer of Health area,
Beruwala ,Sri Lanka however exclusive breast feeding up to 6 mothers is still low and the
prevalence of inappropriate feeding practices is high.12
Kumar D, Agarwal N, Swami HM[2006] cross sectional study on socio demographic
correlates of breast feeding in urban slums of Chandigarh among 270 mothers .The study
reveled that out of all 270 159[58.9%] initiated breast feeding
Only, 43 [15.9%] discarded colostrums and 108[40.01%] mothers gave prelacteal feed.
Illiterate/just literate mothers who delivered at home were found at high risk of delay in
initiation of breast feeding .The study was concluded that promotion of institutional
delivers, health education to mothers for protecting and promotion of breast feeding
practices.3
Monika Kaushal, Rajiv Aggarwal, Ashwani Singal[2005] conducted study on to
evaluate the knowledge of mothers and grand mothers regarding breast feeding and
health –seeking behaviour for neonatal sickness in a rural community New Delhi. A
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cross-sectional survey structured questionnaire method was used most of grand mothers
and mothers believed in early feeding within 2hours of delivery, they often administered
prelacteal feeds such as ghutti and honey. The results of the study indicated that
knowledge regarding desirable breast feeding practices was inadequate and quite a few in
appropriate beliefs were widely prevalent.6
Sachdev HP, Mehrotra S.[2004] conducted a cross multivariate comparison on
predictors of exclusive breast feeding in early infancy among 501 mothers of children
between the age group of 0-6 months at urban teaching hospital opd ,New Delhi. The
study reveled that exclusive breast feeding until 6 months of age was practiced by 307
mothers [61.3%],158 infants [31.5%] were partially fed and 36(72%) were receiving no
breast milk , in sufficient milk supplies, inferred from the infant’s crying, was the reason
given for breast milk supplementation by 52.3% of mothers who initiated this practice,
among mothers who had totally weaned their infant, 28% cited breast rejection by the
baby as the cause. These finding suggest a need for educational campaigns aimed at
supporting breast feeding mothers especially those who perceive their milk supply to be
inadequate.10
Radhakrishnan R, Mini Jacob S, Parameshwari S (2003) conducted study on
exclusive breast feeding practices among women visiting institute of obstetrics and
gynecology at Chennai(Urban) Tamil Nadu, India and government head quarters hospital
at Namakkal (rural). In this study 1000 mothers were taken. The results of the study 89%
of mothers in Chennai and 84% of mothers were aware the benefits of breast feeding,
41% of mothers at Chennai and 62% mothers at Namakkal fed their infant with sugar
water, honey and jaggery water soon after the delivery 39 % of mothers in Chennai and
24% mothers in Namakkal practiced exclusive breast feeding with the average duration
of 2.8 and 2.6 months. 90% feed their infant with colostrums at Chennai and 85% at
Namakkal. The study concluded that exclusive breast feeding is uncommon especially
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among in rural women the prelacteal traditional feeding practices have to be discouraged
by educating prospective mothers, counseling on exclusive breast feeding for at least 6
months need to emphasized at antenatal clinics to all pregnant women.8
STATEMENT OF PROBLEM:
A STUDY TO ASSES THE KNOWLEDGE AND PRACTICES
REGARDING EXCLUSIVE BREAST FEEDING AMONG PRIMI PARA
MOTHERS IN POSTNATAL OUT PATIENT DEPARTMENT AT DISTRICT
HOSPITAL , BELLARY. WITH A VIEW TO DEVELOP AN INFORMATION
GUIDE SHEET.
6.4 Objectives of the Study
To asses the level of knowledge on exclusive breast feeding among primi
Para mother s.
To asses the knowledge on practices of exclusive breast feeding among primi Para
mothers.
To determine the association between the knowledge and practices of
exclusive breast feeding among primi Para mothers.
To determine the association between the knowledge of exclusive
breast feeding and demographic variables.
To determine the association between the knowledge on practices
and demographic variables.
To develop an information guide sheet on exclusive breast feeding.
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6.5 NULL HYPOTHESIS:
* There is no significant association between knowledge and
Selected demographic variables on exclusive breast feeding.
* There is no significant association between demographic variables and
Practices of exclusive breast feeding.
RESEARCH VARIABLES;
[a]. Dependent variable: Knowledge of exclusive breast feeding among primi para
mothers attending to postnatal OPD
[b] Attribute variables: Age, type of family, education, income, and
Occupation.
6.6 OPERATIONAL DEFINITIONS:
Assessment: To estimate the knowledge of prim Para mothers
regarding exclusive breast feeding.
Knowledge: It refers to the correct response of prim Para mothers
giving breast feeding to the child
Practice: The detailed description of breast feeding and maintenance of
health status of child and mother.
Exclusive Breast Feeding: It means giving only breast milk with out
giving water, liquids. Teas, foods, through the first six months of life.
Primi Para mothers: It refers to the mothers who gave birth to child at
first time.
Information guide sheet: It refers to self explanatory information sheet
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prepared by the investigator regarding exclusive breast feeding
importance and purposes and practices.
6.7 ASSUMPTIONS:
The study is based on following assumptions
Most of the primi para mothers may not have adequate knowledge
regarding exclusive breast feeding.
It assumed that primi para mothers may not have adequate knowledge on
practices of exclusive breast feeding.
6.8 LIMITATIONS:
The study is limited to:
* Primi Para mothers giving breast feeding to the child.
* Primi Para mothers who are attending to postnatal OPD
* Primi Para mothers who are available on the day of data
Collection.
* Who are attending to postnatal OPD at district hospital who can
. understand Kannada and English.
*primi Para mothers who are willing to participate in the study.
7. MATERIALS AND METHODS
7.1. Source of Data : Data will be collected from Primi para mothers
who are attending to postnatal O.P.D.
7.2. Method of Collection of Data
7.2.1 Definition of the Study Subject : Primi Para mothers
7.2.2. Inclusion and Exclusion Criteria
a) Inclusion Criteria :
1) Primi Para mothers who are attending to postnatal O.P.D.
at district hospital.
2) Primi Para mothers who are willing to participate in the study
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3) Primi Para mothers who are available on the day of data
collection
4) Primi Para mothers who are attending to post natal O.P.D.
Who can understand Kannada and English
b) Exclusion Criteria :
1) Primi Para mothers who are attending to postnatal O.P.D.
at district hospital.
2) Primi para mothers who are not attending to postnatal OPD
3) Primi para mothers who are not willing participate in the
study
4) Primi Para mothers who are sick/ill.
7.2.3. Research design : Descriptive in nature
7.2.4. Setting : Primi Para mothers who are attending to
postnatal O.P.D. at district hospital.
7.2.5. Sampling Technique : Convenient sample
7.2.6 [a] Sample Size : 100
[b] Duration of the study :
7.2.7 Tools of Research
→ The investigator will asses the socio demographic variables
Such as age, family type, education, income, occupation
cultural believes, place of delivery, delivery conducted by.
→ The investigator will develop structured questionnaire and
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attitude scale to asses the knowledge and practices of primi
para mothers.
→ The investigator will develop and provide an information
guide sheet based on the assessed knowledge and
practices regarding exclusive breast feeding.
7.2.8 Collection Of Data :
The investigator will collect the data by using structured
Questionnaire.
7.2.9 Method of data analysis and Presentation :
a)The investigator will be used descriptive and, inferential
Statistical techniques for data analysis.
b) Descriptive statistics such as frequency, percentage and
standard deviation will be used for analyzing the
demographic variables and knowledge and practices of
exclusive breast feeding.
c) Inferential statistics : chi-square test will be used to
associate the relationship between demographic variables
with the knowledge and practices of exclusive breast
feeding.
7.3. Does the study require any investigation to be conducted on patient or other
human or animals? If so please describe briefly?
Yes, study will be conducted on primi para mothers regarding exclusive breast
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feeding knowledge and practices
7.4 Has ethical clearance has been obtained from your institution in case of 7.3?
→ Yes, informed .Consent will be obtained from concerned subjects and
authority of institution.
→ Privacy, confidentiality and anonymity will be guarded.
→ Scientific objectivity of the study will be maintained with honesty and
impartiality.
8. LIST OF REFERENCES.
1.Field E, Siziva S, etal, Study on Potentials and Barriers in the Promotion of Exclusive Breast Feding ,2008, Nov 5;3 [1];26.
2. Kramer Met al, Study on Promotion of Breast Feeding, Intervention Trial, Journal of the American association, 2001.
3.Kumar D, Agarwal N, Swami H.M, study on Socio Demographic Correlates of Breast feeding, 2006 Nov 60[1]; 461-6
4.Ms.Lakhwinder Kaur, Mahinder Kaur, Study on Importance of Breast Feeding Role of Health Professionals, Indian Journal of Holistic Nursing ,Vol -2,Nnnov-4, 2007,pag-25- 26.5. Lakhwinder kaur, Raman Kalia, etal,Study on Promotion of Breast Feeding Practices, Nightingale Nursing Times, Vol-3,issue-10, 2008, pag-57-58.
6. Monika Kaushal, Rajiv Aggarwal,etal, Study on Breast Feeding Practices and Health Seeking Behavior for Neonatal Sickness in a rural communities, 2005, 51[6];366-376.
7. S.S Prabhudeva, Study on Breast Feeding, Nightingale Nursing Times, Vol-3, issue-5,2007, pag-3.
8. RadhaKrishnan R,Mini Jacob S, etal, Study on Exclusive Breast Feeding Practices 2003,8[1];1066.
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9. Rinda John, , Study on Knowledge, Attitude and Practices of Employed mothers onBreast Feeding, Nurses of India, vol-6, issue-1, 2005, pag-5-6.
10.Sacdev HP, Mehrotra S, Study on Predictors of Study on Exclusive Breast Feeding Practices in early Infancy, 2004, Dec;32[12];1287-96.
11.Mrs v. Selvanayaki, Study on Knowledge, Attitude and Practices of Employed mothers on Breast Feeding , Nurses of India, Vol-9,issue-5,2008,pag-11-12.
12. Suneth b, Agampodi, Thilin C, Agampodi, Study on Breast Feeding PracticesIn a Public Health Field Practice area, 2007.
13. Suraj Gupta,2004, The Short text book of Pediatrics, 10th edi New Delhi,Jaypee Brothers Medical Publishers, pag-113-116.
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9. Signature of Candidate : 10. Remarks of the Guide : The topic selected for the research Study is relevant as because of
knowledge and practices among the mothers about exclusive breast feeding it leading to malnourishment, mortality and morbidities among children.
11. NAME&DESIGNATION OF11.1 GUIDE : Smt. BUELA
H.O.D Department of Community Health Nursing,Indian College of Nursing, Bellary.
11.2 SIGNATURE :
11.3 CO-GUIDE : SUNITHA LECTURERDepartment of Community Health Nursing,Indian College of Nursing, Bellary.
11.4 SIGNATURE :
11.5 HEAD OF THE : Smt. BUELA DEPARTMENT H.O.D Department of
Community Health Nursing,Indian College of Nursing, Bellary.
11.6 SIGNATURE :
12. 12.1 Remarks of the : I discussed with the Principal Research Committee I felt research problem
is good and feasible.
12.2 Signature :
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ETHICAL COMMITTEE CLERANCE
1.TITLE OF THE DISSERTATION : Study to asses the knowledge and practices regarding exclusive breast feeding among primi Para mothers in postnatal opd at district hospital, Bellary .with a view to develop an information guide sheet.
2. NAME OF THE CANDIDATE : Miss UMADEVI .A 1st Year M.Sc.Nursing
Indian College of Nursing Tilak Nagar, Bypass road, Bellary [dist], KARNATAKA.
3. SUBJECT : COMMUNITY HEALTH NURSING.
4. NAME OF THE GUIDE :
5. APPROVED/NOT APPROVED: [If not approved, suggested]
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RAJIV GANDHI UNIVERSITY OF HEALTH SCEINCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF
SUBJECT FOR DISSERTATION1. NAME OF THE CANDIDATE : Miss. UMA DEVI. A
AND ADDRESS IST YEAR M.Sc. NURSING
INDIAN COLLEGE OF NURSING,
TILAK NAGAR, BYPASS ROAD,
BELLARY – 04
2. NAME OF THE INSTITUTION : INDIAN COLLEGE OF NURSING,
TILAK NAGAR, BYPASS ROAD,
BELLARY – 04
3. COURSE OF STUDY & SUBJECT : IST YEAR M.Sc. NURSING
COMMUNITY HEALTH NURSING
4. DATE OF ADMISSSION : 16/06/2008
5. TITLE OF THE TOPIC : A STUDY TO ASSESS THE
KNOWLEDGE AND PRACTICES
REGARDING EXCLUSIVE BREAST
FEEDING AMONG PRIMI PARA
MOTHERS IN POSTNATAL OPD AT
DISTRICT HOSPITAL, BELLARY.WITH
A VIEW TO DEVELOP AN
INFORMATION GUIDE SHEET.
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